Treatment of Guillain-Barre syndrome abroad
Guillain-Barré syndrome or acute idiopathic polyneuritis is a complex of the sensory, movement and autonomic disorders that appear as a result of autoimmune reaction of the body. This pathology has an acute course.
An ill person can often die without urgent hospitalization and emergency care if having Guillain-Barré syndrome. A person might have the residual functional disorders after Guillain-Barré syndrome course which can lead to disability.
Guillain-Barré syndrome - Causes
Autoimmune inflammation is a direct cause of the Guillain-Barré syndrome. The trigger factor usually is one of the following:
- Campylobacteriosis (increases the risk of Guillain-Barré syndrome by 100 times within 2 months)
- Other infections (HIV, cytomegalovirus, mycoplasmosis, measles)
- Vaccination ((influenza, tetanus, rabies)
- Medicines administration (thrombolytics, isotretinoin)
- Acute poisoning by toxins
- Tumors (lymphomatoidgranulomatosis)
- Autoimmune systemic diseases (lupus erythematosus)
Guillain-Barré syndrome - Symptoms
First clinical signs of the Guillain-Barré syndrome are:
- Muscle weakness
- Numbness feeling in the legs
- Crawling sensation
Guillain-Barré syndrome is peculiar with move mentand sensory disorders spreading to the upper extremities with in several hours after the onset of the Occasionally, the first symptoms can be expressed by dysphagia (swallowing disorder), ptosis (eyelid droop), and diplopia (double vision).
Three kinds of disorders are characteristic for the classical form of Guillain-Barré syndrome.
1. Movement disorders are the most dangerous as they trigger the respiratory insufficiency among 30% of patients.
The stage of the disorders severity is verified based on the score from 1 to 5:
- 1 – minimal disorders
- 2 – person can walk up more than 5 meters without assistance
- 3 – person can walk 5 meters and more with assistance
- 4 – person cannot walk even 5 meters with assistance
- 5 – person requires artificial lung ventilation (ALV)
The majority of patients have their cranial nerves affected. Most often these are the seventh, ninth and tenth pairs. Pareses of facial muscles are the basic symptoms.
2. Sensory disorders. Majority of patients observe the increase of sensitiveness in the feet and hands. Buttocks and lower back are the second zone of the involvement in terms of frequency. 50% of patients have deep sensory disorders like vibration, muscle and joint sensitiveness.
3. Autonomic disorders mean increased or decreased blood pressure. Heart rate is more often increased than low. Constipation and, rarely, diarrhea are among the symptoms. Sweating isincreased. Sometimes, pelvic organs functions are also affected. Most often, it is urinary retention. If this happens, disorders are normally transient and are mild.
Guillain-Barré syndrome - Diagnostics
Guillain-Barrésyndrome is diagnosed on the basis of the neurological examination of the patient. Main criteria are:
- Progressing muscle weakness on two and more extremities
- Tendon reflexes are absent
Additional criteria for the diagnosis are:
- Increase in muscle weakness
- Sensory system disorders
- Abnormal asymmetry of the movement
- Paresis of the facial muscles
- Presence of an autonomic disorders
- Absence of fever
Lumbar puncture is done as protein concentration gets higher in the cerebrospinal fluid but no earlier than in a week after the disease onset. Leucocytes concentration in the same fluid sometime exceeds 10/mm.
Electromyography is one of the basic diagnostics techniques and is based on the registration of electrical activity in skeletal muscles.
Though MRI doesn’t allow detecting Guillain-Barrésyndrome, it assists with doing differential diagnostic procedures. MRI is applied if there are some doubts regarding the illness and in the search of other possible reasons of movement, sensory and autonomous disorders.
Auxiliary diagnostics techniques are:
- Spirometery or pneumometry (evaluation of the external respiration) is performed to determine the necessity of AVL use
- ECG is done because a patient may require a temporary pacemaker if having persistent cardiac arrhythmias
- Serological tests are aimed at identifying infections that could become a trigger in the development of Guillain-Barre syndrome
Treatment of Guillain-Barré syndrome abroad
They treat Guillain-Barrésyndrome with the help of conservative therapy, emergency resuscitation procedures and rehabilitation to help a patient restore his health after the treatment course.
Conservative therapy is directed at the options like:
- Blocking autoimmune inflammatory process
- Maintaining patient’s vital functions
- Elimination or reduction of the main manifested symptoms
Intravenous immunoglobulin G or plasmapheresis injections are used to reduce the manifestations of the autoimmune process. These techniques are indicated if a patient has movement disorders of stage 4 or 5.
Following procedures might be necessary to support the patient’s vital activities:
- Artificial lung ventilation (ALV) is commonly applied for several days or weeks or more than a month, but it happens seldom. If ALV is provided for more than 10 days, than a tracheostomy (a tube is inserted directly into the trachea through an incision in the neck and lets the oxygen flow through) is required.
- Establishment of an artificial pacemaker is necessary for treatment of severe brady-arrhythmias, when there is a risk of circulatory failure.
- PEG tube establishment is required to deal with bulbar disorders when a patient is unable to eat on his own and the food is introduced directly into the stomach.
Symptomatic therapy includes the use of the medicines for the intravenous infusion, to lower the blood pressure, to control the heart rate frequency. Pain is blocked with painkillers. Bacterial infectious complications are treated with the antibiotics and so on, depending on the course of certain clinical case.
After patient is discharged from the hospital, he needs a rehabilitation period to restore all the movement functions. In the innovative European hospitals they start to use massage, physiotherapy treatment, acupuncture and other rehabilitation measures even while a patient is still in the hospital. When patient is discharged, he requires remedial gymnastic, physiotherapy, spa-treatment. Therapeutic techniques involving heating of certain parts of the body are contraindicated.
Guillain-Barré syndrome - Prognosis
Mortality of the patients having Guillain-Barrésyndrome is about 5%. Main reason of the death is respiratory failure. Other, seldom met causes of the lethal outcome are:
- Aspiration pneumonia
- Pulmonary embolism
Patient’s age is a key factor of the prognosis. Mortality of children up to 15 years old is just 0,7%. Elderly people over the age of 65 die in 8,6% of cases.
Various negative prognostic factors are:
- Need in ALV for more than 30 days
- Chronic pulmonary diseases in the medical history
85% of patients fully recover after the treatment. Residual effects are observed among 15% of patients. People after the age of 60 and patients suffering from the long neuron damage are in the risk group (determined with the help of neurophysiological tests).
Treatment in German hospitals helps to not only minimize the risk of death, but to fully recover after the illness. Rehabilitation terms for the majority of patients are 6-12 months in average. Recurrence risk of Guillain-Barrésyndrome is about 4%.